- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $3,235.94 / $8,317.64
| Facility | | $89.13 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $602.56
| Professional | | $398.11 | $512.86 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $208.93 / $537.03
| Facility | | $75.86 | $208.93 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $114.82 / $1,288.25
| Facility | | $77.62 | $114.82 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |